Saliva - a new opportunity for fluid biopsy.

Saliva is a complex biological fluid with a variety of biomolecules, such as DNA, RNA, proteins, metabolites and microbiota, which can be used for the screening and diagnosis of many diseases. In addition, saliva has the characteristics of simple collection, non-invasive and convenient storage, which gives it the potential to replace blood as a new main body of fluid biopsy, and it is an excellent biological diagnostic fluid. This review integrates recent studies and summarizes the research contents of salivaomics and the research progress of saliva in early diagnosis of oral and systemic diseases. This review aims to explore the value and prospect of saliva diagnosis in clinical application.

Updates and Original Case Studies Focused on the NMR-Linked Metabolomics Analysis of Human Oral Fluids Part III: Implementations for the Diagnosis of Non-Cancerous Disorders, Both Oral and Systemic.

This communication represents Part III of our series of reports based on the applications of human saliva as a useful and conveniently collectable medium for the discovery, identification and monitoring of biomarkers, which are of some merit for the diagnosis of human diseases. Such biomarkers, or others reflecting the dysfunction of specific disease-associated metabolic pathways, may also be employed for the prognostic pathological tracking of these diseases. Part I of this series set the experimental and logistical groundwork for this report, and the preceding paper, Part II, featured the applications of newly developed metabolomics technologies to the diagnosis and severity grading of human cancer conditions, both oral and systemic. Clearly, there are many benefits, both scientific and economic, associated with the donation of human saliva samples (usually as whole mouth saliva) from humans consenting to and participating in investigations focused on the discovery of biomolecular markers of diseases. These include usually non-invasive collection protocols, relatively low cost when compared against blood sample collection, and no requirement for clinical supervision during collection episodes. This paper is centred on the employment and value of 'state-of-the-art' metabolomics technologies to the diagnosis and prognosis of a wide range of non-cancerous human diseases. Firstly, these include common oral diseases such as periodontal diseases (from type 1 (gingivitis) to type 4 (advanced periodontitis)), and dental caries. Secondly, a wide range of extra-oral (systemic) conditions are covered, most notably diabetes types 1 and 2, cardiovascular and neurological diseases, and Sjögren's syndrome, along with a series of viral infections, e.g., pharyngitis, influenza, HIV and COVID-19. Since the authors' major research interests lie in the area of the principles and applications of NMR-linked metabolomics techniques, many, but not all, of the studies reviewed were conducted using these technologies, with special attention being given to recommended protocols for their operation and management, for example, satisfactory experimental model designs; sample collection and laboratory processing techniques; the selection of sample-specific NMR pulse sequences for saliva analysis; and strategies available for the confirmation of resonance assignments for both endogenous and exogenous molecules in this biofluid. This article also features an original case study, which is focussed on the use of NMR-based salivary metabolomics techniques to provide some key biomarkers for the diagnosis of pharyngitis, and an example of how to 'police' such studies and to recognise participants who perceive that they actually have this disorder but do not from their metabolic profiles and multivariate analysis pattern-based clusterings. The biochemical and clinical significance of these multidimensional metabolomics investigations are discussed in detail.

Evaluation of dental demands and needs of people experiencing homelessness in the city of Rome, Italy

OBJECTIVE: Poor oral health and oral diseases are common among people experiencing homelessness. The aim of this study was to evaluate the dental demands and needs of a population of homeless persons in the city of Rome, Italy. PATIENTS AND METHODS: The clinical records of 165 homeless patients admitted between October 2020 and October 2021 to the dental service of the Primary Care Services of the Eleemosynaria Apostolica, Vatican City, were retrospectively reviewed. The service employed dentists to evaluate dental needs and oral conditions in patients experiencing homelessness. The main dental and oral pathological conditions were noted. RESULTS: One hundred and sixty-five records of homeless patients were included in the study. The sample consisted in 138 males (76.97%) and 27 females (23.03%) with a mean age of 46.9 years (range 7-85 years). Acute tooth pain was reported by 132 (80%) patients, 42 (25.45%) had edentulism or missing teeth and 18 (10.91%) patients had oral lesions. Both dental and oral pathologies were intercepted and managed in secondary health-care facilities. CONCLUSIONS: Given the specific peculiarities of this vulnerable population, it is import-ant to implement strategies that facilitate the access of persons experiencing homelessness to dental evaluation with a preventive and curative perspective.

Research progress on oral characterization of Corona Virus Disease 2019

Corona Virus Disease 2019 (Corona Virus Disease 2019，COVID-19) has become a public health emergency that has attracted global attention because of its large-scale outbreak resulting in numerous human infections and deaths. COVID-19 is a highly contagious respiratory disease caused by novel coronavirus 2019-nCoV. Due to a large number of infections and fast transmission speed, it's significant to diagnose the infected people quickly and detect the asymptomatic infected people as soon as possible. At present, the preliminary screening is judged by the clinical manifestations of the patients, mainly involving the respiratory system, but recent studies have found that the patients infected with COVID-19 have unique oral manifestations, such as taste disturbance, xerostomia, halitosis, inflammation of salivary glands, necrotizing periodontal disease and some of them are earlier than typical symptoms such as dry cough, fever, etc. Paying attention to the oral manifestations of patients can further improve the COVID-19 screening procedure. At present, symptomatic treatment is mainly used for these oral symptoms. © 2022, J Prev Treat Stomatol Dis. All rights reserved.

Perspectives of Australian nursing educators on the preparation of nursing students for the care of older people's oral health

Nurses can and need to take a leadership role in improving and maintaining older Australians' oral health in community, hospital, and residential care settings. [...]it is important to investigate the perspectives of nursing educators on the preparation of nursing students for the care of older people's oral health. Keywords: aged care, oral health, nursing, older people, nursing curricula, dental care, interprofessional and collaborative practice INTRODUCTION The oral health of many older Australians (65 years and above) remains poor despite an increased understanding of the importance of oral health and its association with general healths 2 Due to blood-borne pathogens from the mouth, oral diseases worsen heart problems, diabetes, and pneumonia, leading to unplanned hospitalisations.3"5 Poor oral health also increases the severity of complications arising from viral infections, including COVID-19.6,7 Predominant oral health issues for older people include tooth decay, gum diseases, dry mouth, tooth wear, and oral cancer.8 Poor oral health leads to oral pain, difficulties in eating, speaking, and swallowing as well as lower self-esteem due to bad breath and poor facial and dental appearance.9 Maintaining oral health - a mouth free of pain, discomfort and disease - is key to maintaining the quality of life and general health of older people.10 In providing oral healthcare, nurses need to understand the factors affecting people's oral health and oral healthrelated quality of life, ensure daily oral care practice, and be able to complete an oral health screening to identify issues needing timely referral to a dentist, doctor, or allied health specialist.11 Oral healthcare for older people has been promoted by Australian government-funded learning resource packages such as "Better Oral Health in Residential Care" and "Better Oral Health in Home Care".12 These resources were developed a decade ago to educate and assist nurses, nursing assistants, and allied health professionals to collaborate with dental professionals to ensure effective oral healthcare for the older population.12 However, the uptake of these learning resource packages appears limited, and the report of the Royal Commission into Aged Care Quality and Safety highlighted the continuing neglect of older people's oral health, particularly in residential care.13 Similar concerns have been raised about the oral healthcare of older people in hospitals in Australia.14 As people age, many become frail and require assistance with oral care. The importance of nurses in providing oral healthcare has been acknowledged in international reports and studies.15-18 Restrictions to dental services during the COVID -19 pandemic have highlighted the need for the leadership of nurses in oral healthcare, working closely with dentists, doctors, and allied health professionals to maintain older adults' oral and general health.19 Nursing curricula need to specify the knowledge and clinical competence requirements for the effective provision of oral healthcare to ensure that all graduating students are well-prepared to provide such care.11 Despite the acknowledged association between poor oral health and general health, 13, 20-22 there is little known about the extent of the preparation of nursing students in Australia to provide oral healthcare for older people.11 A review of the curricula of Australian Bachelor of Nursing programs, as presented on university websites, by the first author (VB) showed no information regarding the inclusion of units and clinical practice addressing the care of older people's oral health. Competence in oral healthcare may be implied in current Australian Nursing and Midwifery Accreditation Council (ANMAC) Standards (Standard 3.6 does require nursing programs to integrate principles of interprofessional learning and practice in content and learning outcomes) but there is no particular focus on oral healthcare learning objectives.23 To address this apparent lack of focus on oral healthcare, this study aimed to assess the perceptions of nursing educators regarding the preparation of nursing students to understand and provide effective oral healthcare, particularly for older people.

Efficacy of antiseptic mouthrinses against SARS-CoV-2: A prospective randomized placebo-controlled pilot study.

OBJECTIVES: Coronavirus-disease-19 (COVID-19) continues to affect millions of individuals worldwide. Antiviral activity of mouthrinses remains an important research area as the oral cavity is a site of SARS-CoV-2 initial replication. The aim of this study was to assess the effectiveness of three different mouthrinses in reducing the oral/oropharyngeal SARS-CoV-2 viral load. METHODS: Adult patients, hospitalized with confirmed COVID-19 were recruited for the study. Oral/oropharyngeal baseline SARS-CoV-2 samples were collected and analyzed by Real-Time-PCR. Subsequently, patients were instructed to rinse with 1 % hydrogen peroxide (H2O2), 0.12 % chlorhexidine (CHX), 1 % povidone­iodine (PVP-I) or Sodium Chloride 0.9 % (placebo). Viral loads were measured right after (T1), and at 45 min (T2) from the rinse. RESULTS: In the PVP-I 1 % group, 5/8 (62.5 %) patients at T1, and 3/8 (37.5 %) patients at T2, SARS-CoV-2 was not detectable in the swab specimens. In the H2O2 1 % group, 2/11 (18.2 %) patients at T1, and 2/11 (18.2 %) other patients at T2 showed no SARS-CoV-2 loads. One (12.5 %) patient in the CHX 0.12 % group showed SARS-CoV-2 negativity at T2. One (9.1 %) patient at T1, and another (9.1 %) patient at T2 showed no SARS-CoV-2 loads in the placebo group. CONCLUSIONS: Oral SARS-CoV-2 loads were reduced at T1 in the PVP-I 1 % and H2O2 1 % groups. CLINICAL RELEVANCE: PVP-I 1 % was the most effective rinse especially in patients with low viral copy numbers at baseline.

Application and Performance of Artificial Intelligence Technology in Detection, Diagnosis and Prediction of Dental Caries (DC)—A Systematic Review

Evolution in the fields of science and technology has led to the development of newer applications based on Artificial Intelligence (AI) technology that have been widely used in medical sciences. AI-technology has been employed in a wide range of applications related to the diagnosis of oral diseases that have demonstrated phenomenal precision and accuracy in their performance. The aim of this systematic review is to report on the diagnostic accuracy and performance of AI-based models designed for detection, diagnosis, and prediction of dental caries (DC). Eminent electronic databases (PubMed, Google scholar, Scopus, Web of science, Embase, Cochrane, Saudi Digital Library) were searched for relevant articles that were published from January 2000 until February 2022. A total of 34 articles that met the selection criteria were critically analyzed based on QUADAS-2 guidelines. The certainty of the evidence of the included studies was assessed using the GRADE approach. AI has been widely applied for prediction of DC, for detection and diagnosis of DC and for classification of DC. These models have demonstrated excellent performance and can be used in clinical practice for enhancing the diagnostic performance, treatment quality and patient outcome and can also be applied to identify patients with a higher risk of developing DC.

Oral Microbiome: Getting to Know and Befriend Neighbors, a Biological Approach.

The oral microbiome, forming a biofilm that covers the oral structures, contains a high number of microorganisms. Biofilm formation starts from the salivary pellicle that allows bacterial adhesion-colonization-proliferation, co-aggregation and biofilm maturation in a complex microbial community. There is a constant bidirectional crosstalk between human host and its oral microbiome. The paper presents the fundamentals regarding the oral microbiome and its relationship to modulator factors, oral and systemic health. The modern studies of oral microorganisms and relationships with the host benefits are based on genomics, transcriptomics, proteomics and metabolomics. Pharmaceuticals such as antimicrobials, prebiotics, probiotics, surface active or abrasive agents and plant-derived ingredients may influence the oral microbiome. Many studies found associations between oral dysbiosis and systemic disorders, including autoimmune diseases, cardiovascular, diabetes, cancers and neurodegenerative disorders. We outline the general and individual factors influencing the host-microbial balance and the possibility to use the analysis of the oral microbiome in prevention, diagnosis and treatment in personalized medicine. Future therapies should take in account the restoration of the normal symbiotic relation with the oral microbiome.

Dental Emergencies in an Italian Pediatric Hospital during the COVID-19 Pandemic.

Emergency rooms (ER) are largely used by patients with oral complaints, who choose the ER over private or public dental offices for oral prevention and treatment. During the COVID-19 pandemic, the activity of most dental facilities was limited, and most hospitals and ERs were dedicated to the treatment of COVID-19 patients. The present study analyzed the number of and reason for visits at the emergency room (ER) of Ospedale dei Bambini "Vittore Buzzi", the main pediatric hospital in Milano, Italy, between 2019 and 2020, with a particular focus on oral emergencies. In 2019, 25,435 children turned to the ER, compared to 16,750 in 2020. About 10% of the children were eventually admitted to the hospital in both years. The number of admissions for infectious diseases, other than COVID-19, signed an important decrease in 2020, while trauma/injuries decreased slightly in number but increased in proportion. The number and proportion of ER visits for oral complaints decreased in 2020 compared to 2019. Stomatitis was the most frequent condition, followed by traumatic injuries, which decreased in number and percentage between 2019 and 2020. Oral infections and painful caries accounted for about 15% of the cases in both 2019 and 2020. These data highlight the need to promote territorial services for the prevention and treatment of oral health complaints, including dental emergencies.

Oral health conditions and COVID-19: A systematic review and meta-analysis of the current evidence.

Background: The coronavirus disease 2019 (COVID-19) pandemic has highlighted the importance of understanding the underlying conditions that lead to COVID-19. Oral health has systemic implications in the maintenance of a healthy state. This study aimed to summarize evidence on the prevalence of oral health conditions in participants with COVID-19 and assess the associations between oral health conditions and COVID-19 related outcomes. Methods: Article searches were conducted in five databases and the gray literature from December 1, 2019 to March 1, 2021. Studies that reported oral health conditions for participants with COVID-19 and/or examined associations between oral health and COVID-19 were included. Results: We identified 15 articles that encompassed 5,377 participants with COVID-19 from 10 countries. Dry mouth was the most common oral health condition reported (41.0%), followed by oral lesions (38.8%), orofacial pain (18.3%), and periodontal symptoms (11.7%). Based on the pooled odds ratios (ORs), periodontal symptoms were not associated with COVID-19 positivity (OR = 1.1; 95% confidence intervals [CI], 0.73-1.65) or mortality (OR = 2.71; 95% CI, 0.64-11.51), but were associated with COVID-19 severity (OR = 3.18; 95% CI, 1.81-5.58). Conclusions: Oral health conditions are common in participants with COVID-19 and should be considered in both the onset and progression of this disease. Knowledge in this area is still limited, and the quality of the data extracted was low. Further longitudinal studies are needed to ascertain whether oral health conditions are a consequence of infection with SARS-CoV-2 or whether they predate infection and are risk factors for COVID-19.

Assessment of an Innovative Mobile Dentistry eHygiene Model Amid the COVID-19 Pandemic in the National Dental Practice-Based Research Network: Protocol for Design, Implementation, and Usability Testing.

BACKGROUND: Amid COVID-19, and other possible future infectious disease pandemics, dentistry needs to consider modified dental examination regimens that render quality care, are cost effective, and ensure the safety of patients and dental health care personnel (DHCP). Traditional dental examinations, which number more than 300 million per year in the United States, rely on person-to-person tactile examinations, pose challenges to infection control, and consume large quantities of advanced-level personal protective equipment (PPE). Therefore, our long-term goal is to develop an innovative mobile dentistry (mDent) model that takes these issues into account. This model supplements the traditional dental practice with virtual visits, supported by mobile devices such as mobile telephones, tablets, and wireless infrastructure. The mDent model leverages the advantages of digital mobile health (mHealth) tools such as intraoral cameras to deliver virtual oral examinations, treatment planning, and interactive oral health management, on a broad population basis. Conversion of the traditional dental examinations to mDent virtual examinations builds upon (1) the reliability of teledentistry, which uses intraoral photos and live videos to make diagnostic decisions, and (2) rapid advancement in mHealth tool utilization. OBJECTIVE: In this pilot project, we designed a 2-stage implementation study to assess 2 critical components of the mDent model: virtual hygiene examination (eHygiene) and patient self-taken intraoral photos (SELFIE). Our specific aims are to (1) assess the acceptance and barriers of mDent eHygiene among patients and DHCP, (2) assess the economic impact of mDent eHygiene, and (3) assess the patient's capability to generate intraoral photos using mHealth tools (exploratory aim, SELFIE). METHODS: This study will access the rich resources of the National Dental Practice-Based Research Network to recruit 12 dentists, 12 hygienists, and 144 patients from 12 practices. For aims 1 and 2, we will use role-specific questionnaires to collect quantitative data on eHygiene acceptance and economic impact. The questionnaire components include participant characteristics, the System Usability Scale, a dentist-patient communication scale, practice operation cost, and patient opportunity cost. We will further conduct a series of iterative qualitative research activities using individual interviews to further elicit feedback and suggestion for changes to the mDent eHygiene model. For aim 3, we will use mixed methods (quantitative and qualitative) to assess the patient's capability of taking intraoral photos, by analyzing obtained photos and recorded videos. RESULTS: The study is supported by the US National Institute of Dental and Craniofacial Research. This study received "single" institutional review board approval in August 2021. Data collection and analysis are expected to conclude by December 2021 and March 2022, respectively. CONCLUSIONS: The study results will inform the logistics of conducting virtual dental examinations and empowering patients with mHealth tools, providing better safety and preserving PPE amid the COVID-19 and possible future pandemics. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/32345.

Oral Manifestations of COVID-19: Updated Systematic Review With Meta-Analysis.

There is increasing evidence for oral lesions and manifestations of COVID-19. The aim of this meta-analysis was to investigate the types of oral manifestations of COVID-19 and their prevalence. PubMed/Medline, Scopus, Web of Science, and Google Scholar databases were used to search for publications on oral manifestations in patients with PCR-confirmed COVID-19. A total of 310 records were selected, and 74 were included. Oral lesions in COVID-19 were classified according to their etiologies, including iatrogenic lesions caused by intubation and opportunistic infections. Of the included studies, 35 reported oral lesions probably caused by severe acute respiratory syndrome-Coronavirus-2 (SARS-CoV-2) infection. Meta-analysis of prevalence data on oral manifestations and aphthous lesions indicated high heterogeneity, while meta-analysis of xerostomia prevalence data revealed a pooled prevalence, with considerable heterogeneity. In conclusion, the meta-analysis yielded high heterogeneity between studies: oral lesions yielded a prevalence of 0.33 (95% CI 0.11-0.60), xerostomia lesions a prevalence of 0.44 (95% CI 0.36-0.52) and aphthous lesions 0.10 (95% CI 0.01-0.24). In addition, a gap in the evidence regarding the prevalence of oral lesions in COVID-19 was identified and the need for further observational studies focusing on this issue and on the causal relationships between oral lesions and COVID-19 was highlighted.

Role of mast cells in oral inflammation.

Mast cells play important roles in the maintenance of many physiological functions as well as in the pathophysiology of diseases. Mast cells are involved in the inflammatory mechanisms of many systemic diseases. In this pandemic period, their role in physiological and pathological host inflammatory reactions in tissue disruption following SARS-CoV-2 infection has been stressed. A review of the literature was carried out by entering the key words "Mast Cells" AND "Oral Diseases" AND "Role of Mast Cells in Periodontitis". The results show us that mast cells are definitely involved in many oral diseases including periodontitis. Further in vivo and in vitro studies are needed to further investigate the specific role of the cells in physiological and pathological inflammation.

Taste alteration in COVID-19: Significant geographical differences exist in the prevalence of the symptom.

Early detection of COVID-19 is important for reduction in the spread of the disease and gustatory disturbances (GD) are known to have a strong predictive value. In the present study, we aimed to map the geographical differences in the prevalence of GD in individuals infected with SARS-CoV-2 during the first wave of COVID-19 in order to improve case identification and to facilitate prioritization. We undertook a rapid scoping review of articles published in the repository of the National Library of Medicine (MEDLINE/PubMed) and medRxiv from their inception until 3rd September, 2020. The minimum requirements for completing a restricted systematic review were fulfilled. Of the 431 articles retrieved, 61 studies (28,374 cases confirmed with COVID-19) from 20 countries were included in the analysis. GD were most prevalent in the Americas [66.78%, 95% CI 54.77-78.79%] compared to Europe [57.18%, 95% CI 52.35-62.01%], the Middle East [38.83%, 95% CI 27.47-50.19%] and East Asia [13.1%, 95% CI 0.14-26.06%]. No differences of GD prevalence were evident between February and August 2020. The data demonstrate that there is a marked geographical distribution of GD in COVID-19 patients which, possibly, might be explained by differences in diagnostic criteria for COVID-19 case definition during the early phase of the pandemic.

Treg: A Promising Immunotherapeutic Target in Oral Diseases.

With the pandemic of COVID-19, maintenance of oral health has increasingly become the main challenge of global health. Various common oral diseases, such as periodontitis and oral cancer, are closely associated with immune disorders in the oral mucosa. Regulatory T cells (Treg) are essential for maintaining self-tolerance and immunosuppression. During the process of periodontitis and apical periodontitis, two typical chronic immune-inflammatory diseases, Treg contributes to maintain host immune homeostasis and minimize tissue damage. In contrast, in the development of oral precancerous lesions and oral cancer, Treg is expected to be depleted or down-regulated to enhance the anti-tumor immune response. Therefore, a deeper understanding of the distribution, function, and regulatory mechanisms of Treg cells may provide a prospect for the immunotherapy of oral diseases. In this review, we summarize the distribution and multiple roles of Treg in different oral diseases and discuss the possible mechanisms involved in Treg cell regulation, hope to provide a reference for future Treg-targeted immunotherapy in the treatment of oral diseases.

Covid-19 and oral diseases: Crosstalk, synergy or association?

The coronavirus disease 2019 (Covid-19) is a viral infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that clinically affects multiple organs of the human body. Cells in the oral cavity express viral entry receptor angiotensin-converting enzyme 2 that allows viral replication and may cause tissue inflammation and destruction. Recent studies have reported that Covid-19 patients present oral manifestations with multiple clinical aspects. In this review, we aim to summarise main signs and symptoms of Covid-19 in the oral cavity, its possible association with oral diseases, and the plausible underlying mechanisms of hyperinflammation reflecting crosstalk between Covid-19 and oral diseases. Ulcers, blisters, necrotising gingivitis, opportunistic coinfections, salivary gland alterations, white and erythematous plaques and gustatory dysfunction were the most reported clinical oral manifestations in patients with Covid-19. In general, the lesions appear concomitant with the loss of smell and taste. Multiple reports show evidences of necrotic/ulcerative gingiva, oral blisters and hypergrowth of opportunistic oral pathogens. SARS-CoV-2 exhibits tropism for endothelial cells and Covid-19-mediated endotheliitis can not only promote inflammation in oral tissues but can also facilitate virus spread. In addition, elevated levels of proinflammatory mediators in patients with Covid-19 and oral infectious disease can impair tissue homeostasis and cause delayed disease resolution. This suggests potential crosstalk of immune-mediated pathways underlying pathogenesis. Interestingly, few reports suggest recurrent herpetic lesions and higher bacterial growth in Covid-19 subjects, indicating SARS-CoV-2 and oral virus/bacteria interaction. Larger cohort studies comparing SARS-CoV-2 negative and positive subjects will reveal oral manifestation of the virus on oral health and its role in exacerbating oral infection.

A systematic review of contamination (aerosol, splatter and droplet generation) associated with oral surgery and its relevance to COVID-19.

INTRODUCTION: The current COVID-19 pandemic caused by the SARS-CoV-2 virus has impacted the delivery of dental care globally and has led to re-evaluation of infection control standards. However, lack of clarity around what is known and unknown regarding droplet and aerosol generation in dentistry (including oral surgery and extractions), and their relative risk to patients and the dental team, necessitates a review of evidence relating to specific dental procedures. This review is part of a wider body of research exploring the evidence on bioaerosols in dentistry and involves detailed consideration of the risk of contamination in relation to oral surgery. METHODS: A comprehensive search of Medline (OVID), Embase (OVID), Cochrane Central Register of Controlled Trials, Scopus, Web of Science, LILACS and ClinicalTrials.Gov was conducted using key terms and MeSH (Medical Subject Headings) words relating to the review questions. Methodological quality including sensitivity was assessed using a schema developed to measure quality aspects of studies using a traffic light system to allow inter- and intra-study overview and comparison. A narrative synthesis was conducted for assessment of the included studies and for the synthesis of results. RESULTS: Eleven studies on oral surgery (including extractions) were included in the review. They explored microbiological (bacterial and fungal) and blood (visible and/or imperceptible) contamination at the person level (patients, operators and assistants) and/or at a wider environmental level, using settle plates, chemiluminescence reagents or air samplers; all within 1 m of the surgical site. Studies were of generally low to medium quality and highlighted an overall risk of contaminated aerosol, droplet and splatter generation during oral surgery procedures, most notably during removal of impacted teeth using rotatory handpieces. Risk of contamination and spread was increased by factors, including proximity to the operatory site, longer duration of treatment, higher procedural complexity, non-use of an extraoral evacuator and areas involving more frequent contact during treatment. CONCLUSION: A risk of contamination (microbiological, visible and imperceptible blood) to patients, dental team members and the clinical environment is present during oral surgery procedures, including routine extractions. However, the extent of contamination has not been explored fully in relation to time and distance. Variability across studies with regards to the analysis methods used and outcome measures makes it difficult to draw robust conclusions. Further studies with improved methodologies, including higher test sensitivity and consideration of viruses, are required to validate these findings.

Xerostomia, gustatory and olfactory dysfunctions in patients with COVID-19.

BACKGROUND: The novel Coronavirus Disease-19 (COVID-19) continues to have profound effect on global health. Our aim was to evaluate the prevalence and characterize specific symptoms associated with COVID-19. METHODS: This retrospective study included 326 patients with confirmed SARS-CoV-2 infection evaluated at the Emergency Department of the Umberto I Polyclinic Hospital, Rome, Italy between March 6th and April 30th, 2020. In order to assess xerostomia, olfactory and gustatory dysfunctions secondary to COVID-19, a telephone-based a modified survey obtained from the National Health and Nutrition Examination Survey (NHANES) 2013-2014 for taste and smell disorders and the Fox Questionnaire for dry mouth were administered to 111 patients (34%) after discharge between June 4th and June 12th. RESULTS: Taste dysfunction was the most common reported symptom (59.5%; n = 66), followed by xerostomia (45.9%; n = 51) and olfactory dysfunctions (41.4%; n = 46). The most severe symptom was olfactory dysfunction with a median severity score of 8.5 (range: 5-10). Overall 74.5% (n = 38) of patients with xerostomia, 78.8% (n = 52) of patients with gustatory dysfunctions and 71.1% (n = 33) of patients with olfactory dysfunctions reported that all symptoms appeared before COVID-19 diagnosis. Overall, the majority of patients reported one symptom only (45.9%, n = 51), 37 (33.3%) reported the association of two symptoms, and 23 (20.7%) patients reported the association of three symptoms at the same time. CONCLUSION: Xerostomia, gustatory and olfactory dysfunctions may present as a prodromal or as the sole manifestation of COVID-19. Awareness is fundamental to identify COVID-19 patients at an early stage of the disease and limit the spread of the virus.